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Oral contraceptives containing dl-norgestrel or norethindrone with ethinyl estradiol were administered by random assignment to 21 menstruating women, matched for anthropometric measurements, age, diet, alcohol consumption, smoking, and exercise habits. Pretreatment and 7-week treatment blood samples were obtained and assayed for serum cholesterol, triglyceride high-density lipoprotein cholesterol (HDL-C), and total high-density lipoprotein (HDL), HDL2a, HDL2b, and HDL3subclasses by analytic ultracentrifugation. Subjects using the norethindrone oral contraceptive had a significant increase in HDL-C: baseline, 46 mg/dl; 7 weeks, 51 mg/dl. Values for the subjects using the norgestrel oral contraceptive were not significantly changed; 46 and 44 mg/dl, respectively. Users of the norethindrone oral contraceptive had significant elevations of total HDL and HDL3, while norgestrel oral contraceptive users demonstrated no significant changes. HDL2bincreased with the norethindrone oral contraceptive and declined with the norgestrel oral contraceptive. The changes in HDL2bfrom baseline to treatment were not significant (p > 0.05), but the change with the norethindrone oral contraceptive did differ significantly from that with the norgestrel oral contraceptive (p < 0.02). These changes may indicate oral contraceptive-induced alterations in HDL structure and metabolism that could be related to the risk of development of atherosclerosis.

A random sequential comparative study of three models of the Copper T intrauterine contraceptive device (IUD) was undertaken in 1,792 women. For 7 months, the TCu 300 and TCu 220C were randomly inserted, and then the TCu 380A and 220C were randomly inserted for the next 12 months. The log-rank method of life-table analysis of event rates was performed at the end of each of the first 3 years of use of each device. The TCu 380A had the lowest pregnancy rate during each year of use, although the difference was not significant. At the end of each of the first 2 years, the TCu 300 was removed significantly less than the TCu 220C and TCu 380A for bleeding and pain. At the end of three years, the rates of removal for bleeding and pain for the TCu 380A and TCu 300 were similar and lower than that for the TCu 220C, but the overall difference was not significant. There were no differences among the devices for any other relevant use-related reasons. The TCu 380A was removed for other medical reasons significantly more frequently than the other devices at the end of 2 and 3 years. Adjusting for parity did not alter the results. The findings of this study suggest that the copper sleeves along the horizontal arms together with copper wire on the vertical arm in the TCu 380A model provide greater protection against intrauterine pregnancy, whereas the copper sleeves along the vertical arm as in the TCu 220C caused increased removals for bleeding and pain. The TCu 380A should be studied in a larger number of patients for a longer period of time to determine its clinical effectiveness. It may become the IUD of choice for all women irrespective of parity.

An improved statistical method for assessing the efficacy of intrauterine contraception is presented. This method, called the log-rank method, is based on a daily life table, which yields the best estimates of the cumulative net termination probabilities. It provides a sensitive chi-square test statistic to detect differences among these probabilities for two or more contraceptive devices. Where three or more devices are compared, the chi-square statistic may be partitioned into additive components representing comparisons among groups of devices. The log-rank method also permits adjusting for differences among subgroups by controlling for factors such as parity or age. Although calculations may be performed on a desk calculator, a FORTRAN-IV computer program is made available to interested researchers.

Cesarean section in this series resulted in a high maternal mortality. This may be due to the relatively large number of classical operations performed. During the past four or five years we have done fewer classicals and more cervical sections, and this has resulted in a definitely lower maternal mortality.

A review of 610 cases of primiparous labors in the obstetric service at the Brooklyn Hospital in the last fifteen months, and an intensive study of sixty-one cases in which the vertex was not engaged at the onset of labor, demonstrates that:Failure of vertex engagement cannot be accepted as an indication of disproportion without other direct confirmatory evidence.Persistence of nonengagement after a few hours of labor does not constitute such confirmatory evidence, nor is a so-called "test of labor" significant as demonstrating the feasibility of vaginal delivery. Our study further affirms that, in managing such cases, instead of avoiding vaginal examinations in anticipation of abdominal delivery, a thorough vaginal examination under an anesthetic should be made, at which time the ability of the pelvis to accommodate the infant may be determined and all adjuvant conditions that should govern the management may be studied.Nonengagement per se should not

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